血流储备分数在肾动脉支架植入术中治疗肾动脉狭窄患者的应用价值  

Value of fractional flow reserve in stent implantation for patients with renal artery stenosis

作　　者：何志裕[1] 罗碧辉[1] 陈爱兰[1] 许玲玲[1] 韩敦正[1] 王慧勇[1] 崔同涛 郭涛[1] 杜一鹏[1] HE Zhi-yu;LUO Bi-hui;CHEN Ai-lan;XU Ling-ling;HAN Dun-zheng;WANG Hui-yong;CUI Tong-tao;GUO Tao;DU Yi-peng(Department of Cardiology,The First Affiliated Hospital of Guangzhou Medical University,Guagnzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院心血管内科,广州510120

出　　处：《岭南心血管病杂志》2022年第5期385-390,共6页South China Journal of Cardiovascular Diseases

基　　金：广东省自然科学基金(项目编号:2018A030313060);广州市卫生健康科技项目(项目编号:20201A011072)。

摘　　要：目的探讨血流储备分数(fractional flow reserve,FFR)在肾动脉支架植入术中治疗肾动脉狭窄患者的应用价值。方法选取2014年1月至2018年12月在广州医科大学附属第一医院心血管内科行有创肾动脉造影检查后确诊为肾动脉狭窄并行肾动脉支架植入术的82例患者的临床资料进行回顾性研究,根据术中FFR测定结果分成:极低FFR组(FFR≤0.7,n=12)、低FFR组(0.7<FFR<0.8,n=20)和未进行FFR测量组(n=50),收集并分析了肾动脉支架植入术前、术后1个月和术后12个月患者的血压、血肌酐浓度和口服降压药物种类,随访3组患者12个月主要不良心脑血管事件(major adverse cardiac and cerebrovascular event,MACCE)的发生情况。结果3组患者术后1个月和术后12个月收缩压、舒张压、血肌酐浓度较术前均有明显下降,差异均有统计学意义(P<0.05)。3组患者术后1个月口服降压药物种类均无改变;而3组术后12个月口服降压药物种类降幅比较,差异有统计学意义(P<0.05)。极低FFR组(FFR≤0.7)无论在术后1个月或者术后12个月血压、血肌酐浓度、口服降压药物种类的降幅均最为明显(P<0.05)。随访12个月3组患者MACCE发生率比较,差异无统计学意义(P>0.05)。结论严格手术指征的肾动脉支架植入术能改善肾动脉狭窄患者的血压和肾功能。而通过FFR测定来指导肾动脉支架植入术,能对肾动脉狭窄患者术后血压、肾功能的改善带来更大的获益。Objectives To evaluate the application value of fractional flow reserve(FFR)in stent implantation for patients with renal artery stenosis.Methods A retrospective analysis of clinical characteristics of 82 patients with stent implantation for renal artery stenosis in The First Affiliated Hospital of Guangzhou Medical University from Janu⁃ary 2014 to December 2018 was carried on.Based on FFR,patients were divided into extremely low FFR group(FFR≤0.7,n=12),low FFR group(0.7<FFR<0.8,n=20)and non-FFR group(n=50).Blood pressure,serum concentration of creatinine and types of oral antihypertensive drugs were collected and analyzed before stent implantation,1 month and 12 months after stent implantation in the patients of the 3 groups.Occurrences of major adverse cardiac and cerebro⁃vascular event(MACCE)were followed up for 12 months in the patients of the 3 groups.Results Compared with before stent implantation,blood pressure and serum concentration of creatinine decreased in the 3 groups at 1 and 12 months after stent implantation(P<0.05).Compared with before stent implantation,there was no difference in decreasing num⁃ber of types of oral antihypertensive drugs in the 3 groups at 1 month after stent implantation;types of oral antihyperten⁃sive drugs decreased in the three groups at 12 months after stent implantation(P<0.05).The extremely low FFR group(FFR≤0.7)showed the most significant decrease in blood pressure,serum concentration of creatinine and types of oral antihypertensive drugs at 1 month or 12 months after stent implantation(P<0.05).But there was no statistically significant difference in the incidence of MACCE among the three groups(P>0.05)after 12 months of follow-up.Con⁃clusions Renal artery stent implantation can improve blood pressure and renal function in patients with renal artery stenosis.However,FFR can be used to guide renal artery stent implantation,which can bring greater benefits to the im⁃provement of post-stent implantation blood pressure and renal function.

关 键 词：血流储备分数 肾动脉支架植入术 肾动脉狭窄 

分 类 号：R543.5[医药卫生—心血管疾病]